January 2012 Archives

The elderly are prime targets for financial scams. Persons over the age of 50 control over 70% of the nation's wealth. Yet senior citizens are more likely to have disabilities or impairments that make them vulnerable to manipulation and prevent them from taking action against their abusers. Some older people are unsophisticated about financial matters or unaware of how much their assets have appreciated. Others cannot help but follow a predictable pattern of receiving and cashing in their monthly checks, making it easy for predators to guess when they have money or need to go to the bank. Many times, the very family members and helpers they depend upon are the perpetrators who unduly influence and exploit them.

Financial abuse refers to the theft or embezzlement of an elder's money or property. It includes a wide range of conduct, from the immediate theft of money and property to the use of deception, coercion, or undue influence over time. Perpetrators may also reap financial gain by forging the elder's signature, forcing them to sign a deed, will, or power of attorney, placing charges on their credit cards without permission, or using any fraud, scam, or deceptive act to financially exploit the victim. Sadly, the perpetrator does not have to be in proximity with the victim; AARP estimates that Americans lose $40 billion each year to fraudulent sales pitches that promise a lottery win, prize win, travel package, or "amazing home loan." Over 56% of the victims targeted are aged 50 or older. Some widespread forms of financial elder abuse include:

The California Welfare and Institutions Code defines financial elder abuse as the taking, secreting, or appropriating of an elder's real or personal property for wrongful use or with intent to defraud. The Financial Elder Abuse Reporting Act of 2005 (Act) requires the reporting of any fraudulent use of an elder's drafts, checks, or orders drawn upon any bank, credit union or savings association. Any person who suspects financial elder abuse should report it the local Long-Term Care Ombudsman, local law enforcement agency, or the Bureau of Medi-Cal Fraud and Elder Abuse. Pursuant to the Act, the police, sheriff's department, or district attorney investigating the abuse can then request detailed financial records to corroborate the report.

Following the death of Johnnie Esco at a Placerville facility, an investigation of similar complaints revealed nearly 150 cases of alleged chart falsification in California nursing homes. In Esco's case, the Department of Justice reopened its criminal investigation of El Dorado Care Center (Center), the nursing home that allegedly altered Esco's charts to reflect treatment she never received. After 13 days of neglect, Esco experienced massive bowel obstruction, ultimately leading to her death. Her family sued the Center, alleging fraud, elder abuse, and wrongful death. The family accused the Center of falsifying and altering Esco's medical charts since her admission. The facility remains under civil and criminal investigation for fraud.

Johnnie Esco, 77, was supposed to be recuperating from a bout of pneumonia at a nearby nursing home when her condition suddenly declined. Like many elderly patients, Esco suffered from chronic constipation, which could result in fecal impaction if left unmanaged. Esco's physician therefore ordered that nurses perform routine assessments, checking Esco on every shift for possible constipation. The physician also ordered that Esco receive a laxative or stool softener and milk of magnesia daily. Esco's chart, however, showed no history of constipation or laxative use. The nurses never performed an assessment or asked for Esco's history.

While Esco did not have a bowel movement for five consecutive days, her chart indicated a "zero" constipation. When the doctor ordered an evaluation of the patient's abdominal distention, no one performed it. Esco lay critically ill, but her chart showed she had an "extra large" bowel movement and a temperature of 98.8. While she was bedridden and unresponsive, the Center billed Medicare for 170 minutes of physical therapy and 65 minutes of occupational therapy. It seems nobody looked in on Esco before she died. An autopsy revealed a severe bowel obstruction and fecal impaction, contradicting the notes in Esco's chart.

Esco is not the only patient with a falsified medical chart. A supervisor at a Carmichael facility admitted altering the medical records of a 92-year-old with massive, rotting bedsores. A Santa Monica facility was fined $2,500 for claiming a patient received five days of physical therapy when the nurses responsible for performing the therapy were not at work on those days. Investigations into Medi-Cal Fraud and Elder Abuse reveal that falsification of records in nursing homes is an insidious practice, even when it leads to disastrous human consequences.

Falsifying medical records is a misdemeanor under California law. The California Code of Regulations and Business and Professions Code both require mandatory reporting of the offense. Nevertheless, this is what some providers do "to get the work done." Nursing assistants admit to charting "in bulk," documenting medication and treatment that were never given. Some administrators even re-create records to hide neglectful care. Others falsify forms to sedate patients or backdate forged documents to settle disputes. In a practice where providers rely upon the accuracy of medical charts, sloppy or fraudulent record-keeping takes a serious human toll.